Is mindfulness training helpful for pwBPD

DBT and mindfulness

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This article first appeared on Achtsamleben.at. Courtesy of Dr. Michael E. Harrer may I present this text to you on my website. On his side - as the name suggests - everything revolves around the subject of mindfulness. In addition to detailed explanations, there are many application examples and lots of additional links, tips and interesting sources. Take a look! Here is the link to the original article.


Dialectical Behavioral Therapy (DBT)

The dialectical-behavioral therapy was initially developed in the USA by Marsha Linehan in the early 80s as an outpatient therapy method for the treatment of chronically suicidal Patients developed. It soon became clear that these were mostly women with Borderline disorders acted. Linehan sees the central problem in a disturbance of the emotion regulation: An emotional vulnerability (fast, intense and long-lasting reactions) is connected with the inability to modulate emotions.

After exclusively cognitive-behavioral procedures had proven to be ineffective, Linehan developed the complex Therapy approach of the DBT, which combines cognitive-behavioral interventions (skills training in the group, cognitive restructuring, exposure training, contingency management, behavior analysis) with mindfulness and also integrates humanistic and psychodynamic approaches.

The basic idea is that of dialectic: There is no right or wrong, but different positions that are examined with regard to the achievement of certain goals. For example, the therapist shuttles between the poles of acceptance and change with the aim of creating an atmosphere that is conducive to development. Other polarities are reason and feeling, or doing and being, the synthesis of these poles leads, according to Linehan, to the “wise mind”.

One of the main tasks of the therapist is to provide a validating To maintain a basic attitude. Validation can be described as a careful, non-judgmental but appreciative perception of the patient. Every mindful perception of another is at the same time appreciation.

An essential component of the DBT is the so-called. Skills training. The training manual comprises four modules, with mindfulness being integrated into all four modules:

  1. Inner mindfulness
  2. Training in interpersonal effectiveness
  3. Training of emotion regulation
  4. Stress tolerance

To understand the point of using mindfulness in borderline patients, one can understand that these people are occupied with worrying, self-deprecating, critical, negative and catastrophe-imagining thoughts for most of the day. You lose yourself in the negative evaluation of situations, emotions, thoughts and / or yourself, the tension increases, which leads to dysfunctional attempts at solutions such as self-harm.

In the “Inner Mindfulness” module, the following so-called “what skills” are taught in therapy groups: What am I doing?

  1. Perceive / observe with the 5 senses but also of thoughts and feelings, without fleeing and without holding onto them.
  2. Describe / use language: Finding words for what is perceived from moment to moment, for “what is”, for the “facts” (whereby nothing can be described that has not been perceived) as a step towards self-control (eg differentiating what is perceived from thoughts on it), communication and reality control by comparing it with the perception of other people.
  3. Take part: To be fully focused on one thing and not be distracted by it. This can lead to the experience of "flow" and is not compatible with feelings of boredom or being excluded. Examples: juggling, tightrope walking cannot be done without concentrating on

"How-Skills": How Do I Do It?

  1. Not evaluating / evaluating: "Reality" is what it is, and there are causes. Therefore, what is perceived is neither bad nor good. Things are to be described objectively and neutrally as they really are and it is also important to hear how they are described by others. Not evaluating does not mean approving of everything or not drawing any conclusions. Perceiving without evaluating can help to get out of conceptual schemes and automatisms and to open up to new experiences.
  2. Concentrated: Stay focused or notice distractions such as reviews early on. The evaluation itself does not have to be evaluated either. This helps to stay in the present or to come back to the moment.
  3. Effective: Do what is possible and what works. Keep an eye on the purpose and goals of an action. “Doing the right things at the right time”.

The only mistake a patient can make is to stop practicing.
It is also helpful to note that mindfulness exercises are only possible up to a certain state of tension. Regulation in higher states of tension is taught in the “Stress tolerance” module. In doing so, the focus is more on strong ones outer Stimulates. E.g. the smell of Salmiack.
Mindfulness is closely related to the principle of one "Radical acceptance". So every mindfulness exercise also becomes an exercise in accepting what is. A conceptual or real rejection and a fight against reality are dispensed with. It's about opening up to the experience exactly as it is in each moment. “Radical acceptance means developing the full picture of all cognitions and emotions without converting them into action” (Bohus & Wolf, 2009, p. 81) “Only through the acceptance of what is, the way is possibly cleared for one necessary change ”(Bohus & Wolf, 2009, p. 83).
In the group there are a variety of exercises, e.g. the "Five Senses Mindfulness"

  • See: A person describes a picture that the others cannot see and are supposed to paint according to their instructions; look through a hole in black cardboard and only describe the visible section (for clarification and for practicing the "inner observer");
  • Listen: follow the sound of a singing bowl; a bell ring each time a review is heard; “Sound memory” with film cans filled with different things (sand, rice, etc.);
  • smell: smell coffee beans; perceive smells in nature;
    taste: suck the effervescent tablet; To drink tea;
  • feel: feel a stone; walking barefoot on grass.

Basic assumptions the DBT (after Bohus & Wolf, 2007, p. 52)

  • Borderline patients do their best.
  • You want to change.
  • It takes more effort for them than for others to change.
  • They would do well to learn to solve their difficulties on their own, even if others have caused them.
  • They often experience the situation as painful and difficult to bear.
  • You would do well to learn new behaviors in many situations in your life.
  • You can be successful in the DBT.
  • Truth is always subjective.

further reading (see Achtsamleben.at)

Efficacy studies

  • 31 borderline patients, three-month inpatient DBT, follow-up over 21 months after the end of therapy: the success of the therapy remained stable even after returning to everyday life (Kleindienst et al 2008)
  • Pilot study on 6 Boderline patients with 5 sequential fMRI scans during a 12-week inpatient treatment with DBT: The hemodynamic response to negative stimuli decreased in the right anterior, temporal and posterior gyrus cinguli, as well as in the left islet. 4 people showed decreased responses in the left amygdala and in both hippocampi (Schnell & Herpertz, 2007)
  • 100 borderline patients, control group design DBT (52 weeks) vs. therapy with experts (52 weeks). Follow-up over 2 years: In the DBT group, half of the suicide attempts, fewer hospital admissions and emergency ambulance visits, lower drop-out rate (Linehan et al 2006)
  • 58 borderline patients, control group design DBT (52 weeks) vs. “Treatment as usual”. 6 months after the end of therapy in the DBT group, less parasuicidal and impulsive behavior, less alcohol abuse. No difference in drug abuse (van den Bosch et al 2005)
  • 50 borderline patients, control group design, 31 patients take part in a three-month inpatient program. Four weeks after the end of therapy, less depression, anxiety, better interpersonal "functioning", better social adjustment, reduction in psychopathological symptoms and less self-harm. (Bohus et al 2004)

You can find the original text including the complete list of literature and all links here. Many thanks to Dr. Michael E. Harrer.

Mindfulness DBT Therapy